MALABSORPTION SECONDARY TO MESENTERIC ISCHEMIA

Malabsorption may be caused by chronic mesenteric ischemia.

It may be the initial or the dominant feature of the clinical presentation, with the characteristic postprandial pain of "abdominal angina" not appearing until later in the course. In contrast to other malabsorptive disorders, this condition is distinguished by an onset after the age of 50 years in a patient with evidence of generalized arteriosclerotic disease. An abdominal bruit is also commonly present.

The mechanism of impaired absorption is complex and probably related to abnormalities of intraluminal and mucosal phases of digestion. Both absorption tests and jejunal mucosal histology are useful in documenting the presence of a malabsorptive disorder, but often do not distinguish either its mechanism or underlying etiology.

A small bowel series demonstrating the features of mild dilatation of proximal jejunal loops with stasis, in the absence of hypersecretion and significant segmentation, is helpful in the differentiation of ischemic malabsorption from idiopathic sprue. These roentgenologic features may be of further assistance in selecting patients with malabsorption for aortography to define the presence and extent of potentially remediable vascular occlusions.

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